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General NPI Number Information
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NPI Number | 1679199566
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Entity Type | Organization
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Legal Business Name | ALTA VISTA CENTER FOR AUTISM
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2001 HOYT STREET
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City | LAKEWOOD
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State | CO
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Zip | 80215
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Country | US
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Telephone | 303-759-1192
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 HOYT ST.
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City | LAKEWOOD
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State | CO
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Zip | 80215
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Country | US
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Telephone | 303-759-1192
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Fax | 303-759-1194
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | KEN WINN
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Credential | BCBA
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Telephone | 303-759-1192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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